急性肠系膜上静脉血栓形成的治疗及预后因素分析  

Management and prognosis of acute superior mensenteric venous thrombosis

作　　者：杨玲飞[1] 许俊[3] 刘小孙[2] 金海龙[2] 张卿[2] 高原[2] 沈倩云[2] 于吉人[2] 

机构地区：[1]嘉兴学院医学院 [2]嘉兴市第一医院急诊科 [3]浙江大学医学院附属第一医院胃肠外科,杭州310006

出　　处：《中华普通外科杂志》2016年第2期100-103,共4页Chinese Journal of General Surgery

摘　　要：目的 分析急性肠系膜上静脉血栓形成（acute superior mensenteric venous thrombosis,ASMVT）患者手术和溶栓治疗的预后因素.方法 对51例ASMVT患者进行手术和溶栓治疗并随访,采用COX比例风险模型及Kaplan-Meier法对相关因素进行分析. 结果 本组的ASMVT误诊率高达53％ （27/51）.增强CT扫描对ASMVT确诊率达到96％ （48/50）.51例患者中25例接受手术及术后抗凝治疗,术后复发6例,其中死亡3例;26例接受溶栓治疗及后继抗凝治疗,复发3例,无死亡病例.单因素分析结果显示,肝硬化及门静脉高压病史、脾脏切除术、血栓性疾病史、发病至治疗时间、抗凝治疗时间＜6个月、肠坏死与预后相关（均P＜0.05）;多因素分析结果显示,肝硬化及门静脉高压病史、脾脏切除术、发病至治疗时间＞72 h是ASMVT预后的危险因素（均P＜0.01）.结论 对具有危险因素的急腹症患者应怀疑ASMVT,腹部增强CT可作为确诊该病的首选.Objective To evaluate the outcome of acute superior mesenteric venous thrombosis （ASMVT） and to determine the prognostic factors.Methods Data of 51 ASMVT patients were retrospectively reviewed.Related factors were analyzed by Cox proportional hazard model and Kaplan-Meier analysis.Results 53% （27/51） patients were misdiagnosed in initial stage.Contrast enhanced abdominal multislice spiral CT scan made correct diagnosis in 96% cases （48/50）.25 cases were treated by operation and post-operation anticoagulation,and 6 of 25 cases recurred and 3 died.26 cases were managed with thrombolytic therapy and subsequent anticoagulation.3 of 26 cases suffered recurrence but without mortality.Univariate analysis showed that six variables were associated with the occurrence of ASMVT：（1） Liver cirrhosis and portal hypertension;（2） Splenectomy;（3） Thromboembolic diseases;（4） Onset to treatment time;（5） Duration of anticoagulant therapy less than 6 months;（6） Intestinal necrosis.Multivariate analysis identified three risk factors for poor prognosis：（1） Liver cirrhosis and portal hypertension （RR：3.11,95%CI：2.38-3.57）;（2） Post-splenectomy （RR：2.09,95%CI：1.52-2.44）;（3） Onset to treatment time （RR：1.08,95% CI：1.03-1.41）.Conclusions ASMVT should be suspected when patients with risk factors present with acute abdominal symptoms.Enhanced abdominal multislice spiral CT scan helps establish definite diagnosis in almost all cases.

关 键 词：静脉血栓形成 肠系膜静脉 预后 

分 类 号：R657.2[医药卫生—外科学]